Background:There are very few evaluations of the effectiveness of leadership development programs. The purpose of the study was to examine whether an art-based leadership program may have a more beneficial effect than a conventional one on leaders' and their corresponding subordinates' mental and biological stress. Methods: Participating leaders were randomized to 2 year-long leadership programs, 1 art-based and 1 conventional, with follow-up of the leaders and their subordinates at 12 and 18 months. The art-based program built on an experimental theatre form, a collage of literary text and music, followed by writing and discussions focused on existential and ethical problems. Results: After 18 months a pattern was clearly visible with advantage for the art-based group. In the art group (leaders and their subordinates together as well as for subordinates only) compared to the conventional group, there was a significant improvement of mental health, covert coping and performance-based self-esteem as well as significantly less winter/fall deterioration in the serum concentration of the regenerative/anabolic hormone dehydroepiandrosterone-sulfate. Conclusions: Our findings indicate a more beneficial long-term health effect of the art-based intervention compared to a conventional approach. Positive results for both standardized questionnaires and biological parameters strengthened the findings. The study provides a rationale for further evaluation of the effectiveness of this alternative educational approach.

The aim of this study was to describe age and gender differences in psychosocial aspects of health in adolescents. A further aim was to explore if self-rated behavior problems varied with the adolescents’ general self-concept and sense of coherence.

Methods

Questionnaires on self-rated psychosocial aspects of health were answered by 282 (n = 282/390) randomly selected adolescents, aged 13–22 years (M 17.9/18.0). The instruments used were “I think I am (ITIA),” “Youth Self Report (YSR),” “Sense of coherence (SOC),” and “Family APGAR.” Differences between males and females (cross-individual grouping) were analyzed using nonparametric tests. A cluster analysis was performed using a three-cluster solution to identify and describe profiles (person-centered grouping).

Results

Compared with males, adolescent females scored less favorably on self-esteem (ITIA) (p = .028), reported more behavior problems (YSR) (p = .000), and showed a lower sense of coherence (SOC) (p = .003). The differences were most evident in the age group 15–17 years. The three clusters significantly differed from each other regarding how high proportions of problems the adolescents of each profile reported.

Conclusions

Compared with male adolescents, adolescent females experienced a poorer psychosocial health in somatic, depressive, and internalizing areas. The result indicated that psychological factors had a major impact on the proportions of problems that the adolescents reported.

Purpose: The aim of this study was to describe the relationship between the epilepsy condition (illness severity), sociodemographic factors, general self-concept, and illness-specific attitude in adolescents with uncomplicated epilepsy. Methods: Adolescents, aged 13–22, fulfilling criteria registered in four Swedish hospitals, answered questionnaires (n=149). The instruments “I think I am” and “Sense of coherence” measured the patients’ general self-concept. The “Child Attitude Toward Illness Scale” measured illness-specific attitude. A summary score (index) calculated from seizure frequency, seizure type, and antiepileptic drug (AED) with side effects measured “Illness Severity”. Results: Illness severity was significantly related to the participants’ general self-concept, as well as to their attitude toward their condition; i.e. higher illness severity scores were correlated with lower sense of coherence (SOC), poorer self-esteem, and a more negative attitude towards the epilepsy condition. Females had more severe illness according to the Illness Severity Index, with almost 80% found in the moderate and high severity groups as compared to 63% of males in the moderate/high severity groups. Conclusions: It was concluded that the severity of the epilepsy condition was related to the adolescents’ general self-concept and illness-specific attitude, but further research is needed to understand the causality of the relationship. The brief assessment of illness severity, constructed and used in this study should be addressed and developed further.

This study addressed epilepsy patients' conceptions of epilepsy as a phenomenon and emotions related to those conceptions. Nineteen outpatients were interviewed, and data were analyzed according to the phenomenographical methodology. Patients described epilepsy in six qualitatively different ways: Epilepsy is (a) an illness related to physical disturbances, (b) a condition related to physical disturbances, (c) a mental disturbance related to lack of mental capacity, (d) a handicap related to psychological and/or social aspects, (e) an identity related to being an epileptic, and (f) a punishment. The emotions confidence, happiness, hope, and annoyance were related to epilepsy as an illness or a condition, whereas shame, fear, sorrow, and guilt were related to the other four categories. This study indicated that, to patients, the phenomenon of epilepsy is above all a psychosocial nature and in that dimension closely related to negative emotions.

Purpose - The purpose of the paper is to explore the universality of a qualitatively (grounded theory) developed model of leadership in complex and/or stressful rescue operations.

Design - The model was operationalised and tested on leaders (n = 385) from the ambulance service, the police force, and the rescue services in Sweden. A questionnaire was operationalised from the codes and categories of the previously developed model.

Findings - The study showed that the most important factors in explaining the outcome of complex rescue operations were organisational climate before the incident, positive stress reactions, and personal knowledge of the co-actors during the episode. Cases where the leader appraised that the situation could not be resolved with the available resources were characterised by less favourable ratings, irrespective of whether humans were perceived as being threatened or not. The strength of this controllability aspect was interpreted in terms of a professional action-oriented identity.

Research limitations/implications - The results were affected by a high dropout rate and the fact that there were comparatively few large-scale rescue operations.

Practical implications - The results may be valuable in both training and exercises with rescue operation commanders.

The United Nation's secretary-general from 1953 to 1961, Dag Hammarskjöld, whose spiritual beliefs influenced his political activity, was searching for universality and solidarity as written in the charter of the UN. While in office, Hammarskjöld was able to unite personal belief and political rationale. This is the main reason he became a respected and true international civil servant. Hammarskjöld was neither a pure idealist nor a pure realist. This article examines the moral but not moralistic life and legacy of Hammarskjöld, who united mystics and realistic political engagement. In doing so it draws on the lessons learned from a “practical mystical” and international civil servant. This is chiefly done by using the English School approach of international relations theory while at same time pointing out the impact of positive mimesis. By devoting his private life to God, Hammarskjöld was able to devote his political life to the UN.

Two strategies for solving spatial test items, drawing differently on general ability and visualization, have been shown. These strategies may not only be a matter of individual predilection, but item features may lend themselves more to one or the other strategy. Newly developed techniques for factor analysis and the Mplus program allows items to be analysed as categorical variables together with summarized test results as continuous variables, which enables analyses of the dimensionality of single test items. Five spatial tests in the Computerized Swedish Enlistment test battery were analysed for a representative sample of 18-year old male conscripts (n = 14,925). The items were fitted one by one for each of the five spatial tests together with the rest of the tests into a hierarchical model of intellectual abilities with general (G), verbal (Gc'), spatial ability (Gv') and test specificity (Tspec') as latent variables. All models showed good fit and the items were found generally to load higher on G than on Gv', except for some of the items on the test with limited response time. No systematic increase in G loadings with increasing item difficulty, indicating a shift to an analytical strategy, was revealed.

Vocabulary tests, part of most test batteries of general intellectual ability, measure both verbal and general ability. Newly developed techniques for confirmatory factor analysis of dichotomous variables make it possible to analyze the influence of different abilities on the performance on each item. In the testing procedure of the Computerized Swedish Enlistment test battery, eight different subtests of a new vocabulary test were given randomly to subsamples of a representative sample of 18-year-old male conscripts (N = 9001). Three central dimensions of a hierarchical model of intellectual abilities, general (G), verbal (Gc'), and spatial ability (Gv') were estimated under different assumptions of the nature of the data. In addition to an ordinary analysis of covariance matrices, assuming linearity of relations, the item variables were treated as categorical variables in the Mplus program. All eight subtests fit the hierarchical model, and the items were found to load about equally on G and Gc'. The results also indicate that if nonlinearity is not taken into account, the G loadings for the easy items are underestimated. These items, moreover, appear to be better measures of G than the difficult ones. The practical utility of the outcome for item selection and the theoretical implications for the question of the origin of verbal ability are discussed.

This study maps reactions activated in peacekeeping personnel by life-threatening situations and explores how these reactions affect psychological functioning. In-depth interviews were carried out with 30 informants from the Swedish peacekeeping force serving in Bosnia between 1993 and 1995. All participants had experienced shooting incidents or other highly threatening events. Two models were formed. A descriptive model structures the content of the interviews according to the phase and type of situation from which they were mainly reported, as well as whether they were mainly reported by officers or privates. A theoretical model forms the basis for a discussion about the individual and situational factors that affect the specific reactions and how their interaction with role expectations affects performance. The informants were generally satisfied with their performance. Two factors associated with lower performance were either that the life-threatening situation implied loss of control or it demanded complex cognitive activity.

Some groups have to face threats and dangers professionally with maintained cognitive functioning, which implies a need to know both the extent to which maladaptive reactions occur and the factors that may affect it. This study examines self-reported reactions and performance when facing risks and dangers on peacekeeping observer missions. The sample consisted of 154 military observers. A self-made questionnaire, including the General Health Questionnaire and the Sense of Coherence (SOC) scale, was used. We found that feelings of invulnerability were common in relation to mission risks. In a specific danger incident, most participants subjectively performed well, although partial loss of cognitive functioning was reported in half of the cases and severely dysfunctional reactions in about one tenth. Cluster analysis showed that self-reported cognitive limitations in danger incidents were related to 2 factors: complicating situational factors, such as high levels of threat, complex decision demands, and minor control possibilities; and individual vulnerability factors, such as general worry and anger, low SOC, anxiety, and psychosomatic symptoms.

To develop a patient questionnaire specific to intrapartal care, based on the theoretical foundation of the general instrument Quality from the Patient's Perspective (QPP).

Background.

Existing general patient questionnaires do not take intrapartal care aspects fully into account, and available intrapartal-specific patient questionnaires tend to have a weak theoretical foundation.

Design.

A cross-sectional, nationwide study carried out during a two-week period in 2007 at Swedish maternity units.

Method.

An intrapartal-specific QPP-questionnaire (QPP-I) was developed by combining a selection of 22 items from the short and long versions of the QPP with 10 newly constructed items. Responses were obtained from 739 women (63% response rate). The dimensionality of the QPP-I was assessed using structural equation modelling (a nested factor model). Non-parametric statistics were used for subgroup comparisons.

Results.

A nested model with a general factor including all 32 items and 10 subordinate factors was developed. Most scales had acceptable reliability coefficients (0 center dot 73-0 center dot 93), and a meaningful pattern of subgroup differences was obtained.

Conclusions.

The QPP-I is theory based and has its roots in a patient perspective. It was developed using a nationwide sample of Swedish women receiving intrapartal care, and an advanced statistical method was used. The outcome of this initial empirical trial was promising but needs to be tested in different countries and cultures.

Relevance to clinical practice.

By combining womens' responses on perceived reality and subjective importance ascribed to the various aspects of care measured, the QPP-I offers the care provider better guidelines on which elements to focus quality improvement work on, than would be the case if only a rank order of perceived reality ratings was available.

• Patients' views on the quality of care are important and it is desirable that these can be assessed using short, yet valid and reliable instruments.

• The aim of the work reported here was to develop and test a short version of an established questionnaire: Quality from the Patient's Perspective (QPP).

• Patients (n=162, 79% response rate) receiving care at medical and surgical departments in two Swedish hospitals responded to the original QPP as well as to a newly developed short version. An ethical research committee approved the study.

• Pearson correlations were computed between the long and short forms and differences between means were analysed with t-tests. Reliability was estimated by computing Cronbach alpha coefficients.

• Correlations of acceptable size were found between the short form and the original QPP. The short form also had acceptable reliability coefficients.

• The strengths of the work are that the items in the short version are derived from a patient perspective and are formulated in words used by patients; the items still have a theoretical foundation, which makes the interpretation of results more meaningful; global formulations such as `What do you think about your care?' have been avoided; the short format should make the questionnaire more attractive for many patients to respond to.

• Limitations are that results indicate that the short form does not fully measure what the long form does. Therefore, when the short form is used in practice, a two-step procedure is suggested, where a follow-up is done with a selection of items from the original long form. This selection could be restricted to areas where problems may be suspected, based on the results from the short form.

Background. Advanced medical care in the patient's home setting is becoming more common. Many of the patients who receive this kind of care have severe illnesses and are unable to respond to questions about the quality of care. The research question was: are the patients’ opinions congruent with those of family members?

Aim. To explore and compare the relationship between patients’ perception of the quality of care and close family members’ perception of this care as well as their perception of the patients’ perception.

Methods. Sixty-seven patients receiving advanced home care, 82 family members (54 matched patient + family member pairs) participated. Data were collected using a short version of the quality from the patient's perspective questionnaire modified to advanced home care.

Results. A high degree of perceptual congruence was found between patients and their family members. The similarity was also high between family members’ own opinion and their appraisal of how the patient perceived the care. A subgroup of family members who met the patient once a week or less often deviated from this pattern.

Conclusion. Patients’ views on the quality of care are congruent with the opinions of family members if they meet every day (live together) and share the same everyday and care-related experiences. The results can be understood in the light of empathic accuracy theory.

Relevance to clinical practice. The findings of this study have important implications for clinical nursing practice. Family members’ perception of the quality of care may be a valuable data source for nurses in the case of advanced home care if the patient and family member share the same everyday, care-related experiences, otherwise family members’ perception tend to be more critical than those of the patients themselves.

Aim. The aim was to explore the relationships between the feelings of women who give birth and several birth-related care conditions, the womens' socio-demographic background, personality and perceptions of the quality of intrapartum care. Background. Childbirth is a highly significant emotional event for women and it is an explicit goal that each woman should have a positive childbirth experience. Design. The nationwide study is cross-sectional and was conducted at Swedish maternity units over two months in 2007. Methods. The study group consisted of 739 women (63% response rate). A dimensionality analysis of six emotion items was performed using structural equation modelling (SEM). Non-parametric tests and generalised linear mixed effects model analyses were used to study relationships and to make subgroup comparisons. Results. In the SEM analysis, a positive and a negative feeling factor were identified. Strong associations between the feeling factors and the womens' perceptions of the quality of care were found, particularly in regard to the so-called identity-oriented approach of the midwives and other health professionals. In addition, a higher intensity of negative feelings was associated with a personality pattern characterised by extraversion, emotional instability and lower degree of conscientiousness, a lower level of education and having had delivery through Caesarean section. Conclusions. The positive and negative feelings of women who give birth strongly covary with the women's perception of the quality of their intrapartum care. This pertains in particular to information issues, the midwives showing commitment, empathy and respect, being present during labour and allowing the women to actively participate as much as they want to. Relevance to clinical practice. Subgroup differences indicate that midwives should pay increased attention to childbearing women who have primary school education only, a lower emotional stability and/or deliver through Caesarean section.